Basic Information
| Provider Information | |||||||||
| NPI: | 1366482044 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 COMMERCIAL ST | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032287555 | ||||||||
| FaxNumber: | 6034159470 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 PLEASANT STREET | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032287555 | ||||||||
| FaxNumber: | 6034159470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 04/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5779 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.